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Multiple adverse childhood experiences and mental and physical health outcomes in adulthood: New systematic review protocol assessing causality

    Research suggests that adverse childhood experiences can have a lasting influence on children’s development that result in poorer health outcomes in adulthood. Like other exposure-outcome relationships, however, there is uncertainty about the extent to which the relationship between adverse childhood experiences and health is causal or attributable to other factors.

    The aim of this systematic review is to better understand the nature and extent of the evidence available to infer a causal relationship between adverse childhood experiences and health outcomes in adulthood.

    A comprehensive search for articles will be conducted in four databases (Medline, CINAHL, PsycInfo and Web of Science) and Google Scholar. The team, led by Dr Lisa Jones of Liverpool John Moores University, and includes VISION researchers Professor Mark Bellis and Professor Sally McManus, will review studies published since 2014:

    • of adults aged 16 years or over with exposure to adverse childhood experiences before age 16 years from general population samples;
    • that report measures across multiple categories of childhood adversity, including both direct and indirect types; and
    • report outcomes related to disease morbidity and mortality.

    To download the protocol: Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality

    To cite: Jones L, Bellis MA, Butler N, et al. Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality. BMJ Open 2025;15:e091865.  doi: 10.1136/bmjopen-2024-091865

    For further information, please contact Lisa at l.jones1@ljmu.ac.uk

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    Systematic review: Effectiveness of UK-based adult domestic and sexual violence support interventions and services

      Recommendations

      • Further high-quality research into the effectiveness of domestic and sexual violence and abuse (DVSA) interventions and evaluations of perpetrator programmes are required, including randomised controlled studies where appropriate and ethical, to improve certainty regarding the effect estimates generated from evidence syntheses. Published protocols, adherence to reporting guidelines, such as CONSORT, STROBE and SQUIRE 2.0, and considering and accounting for confounding factors where randomisation is not feasible, will strengthen the research.
      • Developing a core outcome set via co-production with survivors, practitioners and service providers, commissioners, policy makers and researchers will increase consistency in reported outcomes and create the cohesion necessary to develop a robust evidence base to aid understanding of how effective various support services are.

      In the United Kingdom, there are a range of support services and interventions for people who have experienced domestic and sexual violence and abuse (DSVA), including refuges, advocacy such as Independent Domestic Violence Advisors (IDVAs), referral, outreach, and helplines. These are often provided by the Voluntary and Community Sector (VCS), although may also be located in the public or private sector. Due to the lack of consensus on outcomes used to assess effectiveness, evidence syntheses in this field have been limited.

      Dr Sophie Carlisle led a team of VISION researchers, Dr Annie Bunce, Prof Sally McManus, Dr Estela Capelas Barbosa, Prof Gene Feder, and Dr Natalia V Lewis, and Prof Matthew Prina from Kings College London. They used findings from their scoping review to identify the common reported outcomes, to direct and inform an evidence synthesis on the effectiveness of UK-based interventions and services for DSVA.

      The team conducted a systematic review and, where possible, meta-analysis. They searched relevant peer reviewed and grey literature sources. The following were included: randomised controlled trials, non-randomised comparative studies, pre-post studies, and service evaluations of support interventions or services for adults who had experienced or perpetrated DSVA. The intervention typology and selection of outcomes was determined based on co-production with stakeholders from specialist DSVA organisations. The quality of the studies was assessed independently by two reviewers. Where meta-analysis was not possible, the researchers synthesized studies with vote counting based on the direction of effect.

      The review demonstrates that there appear to be benefits of UK-based advocacy and outreach services, psychological support interventions, and perpetrator programmes. However, risk of bias and methodological heterogeneity means that there is uncertainty regarding the estimated effects.

      A co-produced core-outcome set is needed to develop a more robust evidence base and facilitate future research in this field. Research practices such as publishing of study protocols, following reporting guidelines and, for research where randomisation is not feasible, considering and accounting for potential confounding factors, would greatly improve the quality of research.

      To download the paper: Effectiveness of UK-based support interventions and services aimed at adults who have experienced or used domestic and sexual violence and abuse: a systematic review and meta-analysis – PMC

      To cite: Carlisle S, Bunce A, Prina M, McManus S, Barbosa E, Feder G, Lewis NV. Effectiveness of UK-based support interventions and services aimed at adults who have experienced or used domestic and sexual violence and abuse: a systematic review and meta-analysis. BMC Public Health. 2025 Mar 14;25(1):1003. doi: 10.1186/s12889-025-21891-5. PMID: 40087589; PMCID: PMC11908015.

      For further information, please contact Sophie at sophie.carlisle4@nhs.net

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      The impact and risk factors of adolescent domestic abuse: A rapid systematic review

        As a phenomenon, abusive behavior between adolescents in intimate relationships remains relatively invisible, due in part to the persistent yet unfounded assumption that domestic abuse is something that occurs between adults. There is an emerging body of evidence indicating that both victimization and perpetration in intimate partner relationships can and do occur well before adulthood.

        This review seeks to improve understandings of intimate partner abuse between adolescents, focusing in particular on younger adolescents below the age of 16 and the impacts and risk and protective factors.

        VISION researchers Dr Ruth Weir, Dr Olumide Adisa and Dr Niels Blom, with their collaborators, conducted a rapid systematic review by searching three electronic databases (PsycInfo, Embase, and Social Sciences Citation Index). The team utilized pre-existing systematic reviews to identify relevant primary studies. Findings of the included studies were described and summarized using narrative synthesis.

        Seventy-nine studies were identified for inclusion. Synthesis of the findings of these studies identified five categories of risk and protective factors, including bullying and parental intimate partner violence, social and cultural factors, school and neighborhood environment and health and wellbeing. However, the review also identified a gap of qualitative research and a lack of attention to how ADA intersects with cultural factors, gender differences, criminalization, and poor mental health. Many of the studies report on school-based settings, limiting understanding of the role of neighborhood factors in prevention, protection and recovery. Participatory research on help-seeking behaviors of adolescents is rare.

        The review synthesized risk and protective factors associated with ADA, especially those occurring between younger adolescents. It highlighted the complex interplay and overlap between using and experiencing violence and abuse and the need for systematic research to inform the development of advocacy, interventions and prevention that is right for young people.

        Highlights from the VISION ADA rapid review: Gaps, limitations & considerations for future research

        • Little recent academic interest on ADA in the UK
        • Focus in existing global literature on physical or sexual violence but less so on coercive control or emotional / psychological abuse
        • Lack of systematic examination of long-term consequences of ADA on wellbeing
        • Lack of intersectional analysis (ethnicity, sexual orientation, socioeconomic status, etc)
        • Little exploration of adolescents’ help-seeking behaviours and attitudes to different kinds of possible support
        • Research design limitations

        To download the paper: Adolescent Domestic Abuse and Its Consequences: A Rapid Systematic Review | Journal of Family Violence

        To cite: Weir, R., Adisa, O., Blom, N. et al. Adolescent Domestic Abuse and Its Consequences: A Rapid Systematic Review. J Fam Viol (2025). https://doi.org/10.1007/s10896-025-00813-4

        For more information on this rapid review, please contact Ruth at ruth.weir@city.ac.uk

        To view and / or download the list of systematic reviews included in this paper:

        SRs included in Weir ADA journal articleDownload

        Further ADA research across the VISION consortium:

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        Systems analysis of service coordination in domestic abuse, primary care and child mental health services

          The impact of intimate partner violence (IPV) on parental and child mental health is well documented, as is the associated increased use of healthcare services by survivors of IPV. UK policy emphasises the importance of partnership working between health services and domestic abuse agencies, along with clear referral pathways for victims of violence and abuse and co-ordinated local responses. However, in general, current policy and guidance is focused on the response to adult victims with more limited advice as to how this should be operationalised for working with children.

          With first author Dr Claire Powell (University College of London), VISION researchers Dr Olumide Adisa and Professor Gene Feder and others explored how services work together to support parents and children experiencing both parental IPV and parental or child mental health problems by drawing on the perspectives of professionals working in primary care, children and young people’s mental health services (CYPMHS), and domestic abuse services.

          The team conducted a qualitative study, interviewing professionals in geographically contrasting local authority areas in England. They carried out framework analysis using a systems approach and mapping techniques to understand the service interrelationships and boundary judgements of professionals.

          Results showed that

          • The relationships between domestic abuse services, CYPMHS, and primary care were complex, involving funders and commissioners, local authority strategic groups, and wider services such as schools and children’s centres.
          • Participants consistently identified a gap in the relationship between statutory CYPMHS and domestic abuse services.
          • There were mental health service gaps were for children living with ongoing or intermittent IPV and for children and parents with needs falling below or between service thresholds.
          • There was a gap in services for users of abusive behaviour to prevent future IPV.
          • Staff perspectives revealed differing views on treating the effects of trauma, and the co-ordination and sequencing of care.

          Improving the response to children and adults experiencing mental health problems in the wake of IPV requires a systems perspective to understand the barriers to service co-ordination. The findings indicate a particular need to address the gap between CYPMHS and domestic abuse services.

          To download the paper: Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives – ScienceDirect

          To cite the paper:  Claire Powell, Olumide Adisa, Lauren Herlitz, Shivi Bains, Sigrún Eyrúnardóttir Clark, Jessica Deighton, Shabeer Syed, Ruth Gilbert, Gene Feder, Emma Howarth, Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives, Children and Youth Services Review, Volume 169, 2025, 108076, ISSN 0190-7409, https://doi.org/10.1016/j.childyouth.2024.108076

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          Migrants’ experiences of violence while in insecure migration status

            Violence is a major public health issue. Moreover, there is evidence that violence is significantly related to social inequality. Existing studies have found links between violence and gender, ethnicity, place of residence and socioeconomic status.

            Although economic globalization impacts trade, goods, and services, the movement of people has been increasingly restricted since the 1990s. The number of people globally who live with insecure migration status is difficult to estimate, but includes people worldwide undertaking irregular journeys and crossing international borders without authorization, people living without the correct immigration documentation, and people in temporary or dependent statuses in destination countries.

            The global movement of people in the context of strict immigration laws and policies places significant numbers of people in insecure migration status worldwide. Insecure status leaves people without recourse to legal, governmental or social protection from violence and abuse.

            This review synthesized qualitative studies that reported how migrants associated physical and physically enforced sexual violence they experienced with their insecure migration status. VISION researchers, Andri Innes, Annie Bunce, Hannah Manzur, and Natalia V. Lewis, generated robust qualitative evidence showing that women experienced sexual violence while in transit or without status in a host state, and that they associated that violence with their insecure migration status. This was the case across the various geographic routes and destination countries.

            They found evidence that women associated intimate partner violence with lacking (legal) access to support because of their insecure migration status. Women connected their unwillingness to leave violent circumstances, and therefore their prolonged or repeated exposure to violence, with a fear of immigration removal produced by their insecure migration status.

            To protect people in insecure migration status from experiencing violence that they associated with their migration status, it’s necessary to ensure that the reporting of violence does not lead to immigration enforcement consequences for the victim.

            To download the paper: Experiences of violence while in insecure migration status: a qualitative evidence synthesis | Globalization and Health | Full Text

            To cite: Innes, A., Bunce, A., Manzur, H. et al. Experiences of violence while in insecure migration status: a qualitative evidence synthesis. Global Health 20, 83 (2024). https://doi.org/10.1186/s12992-024-01085-1

            For further information, please contact Andri at alexandria.innes@city.ac.uk

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            Reflections on producing evidence syntheses on violence and abuse

              The VISION systematic review team, Dr Natalia Lewis, Dr Elizabeth Cook, Dr Jessica Corsi, Dr Sophie Carlisle and Dr Annie Bunce, presented at the London Evidence Syntheses and Research Use Seminars on 17 July 2024. The event was an initiative jointly hosted by the EPPI Centre (at UCL) and the Centre for Evaluation at London School of Hygiene and Tropical Medicine (LSHTM).

              The team presented under the collective theme Producing evidence syntheses on violence and abuse: reflections on the disciplinary variations and practicalities, with the aim of prompting conversation about how systematic review methodologies can be adapted across disciplines. Dr Natalia Lewis (Systematic Review Lead, University of Bristol) introduced the session, describing the emergence of systematic reviews at the top of the ‘hierarchy of evidence’ that is often referenced in evidence-based medicine. Accompanying systematic reviews are a range of reporting standards, tools and guidance stipulating recommended practices for conducting reviews. However, as the team discussed in their presentations, such standardised frameworks and approaches do not provide space for reflection on the process and implications of adapting these methodologies to evidence on violence and abuse.

              The seminar included the following presentations:

              • Dr Elizabeth Cook (City, University of London): Evidence syntheses in a global context: A systematic review of sex/gender disaggregated homicide.
              • Dr Jessica Corsi (City, University of London): Evidence synthesis on legal records: challenges and adaptations.
              • Dr Sophie Carlisle (Health Innovation East Midlands): Evidence synthesis in the context of UK domestic and sexual violence services: Involving professional stakeholders.

              The presentations are available to view and download below.

              Dr Natalia Lewis, Producing evidence syntheses on violence and abuse: reflections on the disciplinary variations and practicalities

              Lewis – IntroductionDownload

              Dr Sophie Carlisle, Evidence synthesis in the context of UK domestic and sexual violence services: involving professional stakeholders

              Carlisle – Involving stakeholdersDownload

              Dr Elizabeth Cook, Evidence synthesis in a global context: A systematic review of sex/gender disaggregated homicide

              Cook – Homicide in a global contextDownload

              Dr Jessica Corsi, Evidence synthesis on legal records: Challenges and adaptations

              Corsi – Evidence synthesis on legal recordsDownload

              The seminar was held in hybrid format. The talks were recorded and are available through the following link: https://eppi.ioe.ac.uk/cms/Coursesseminars/Previousseminarsandevents/tabid/3317/Default.aspx